Confirming Rupture of Membranes with Intra-Amniotic Fluorescein Dye Test

Introduction We describe two patients presenting with preterm loss of fluid and inconclusive evaluations requiring further assessment. Patient 1 was a 41-year-old G3P1011 at 21 ^6/7 weeks; Patient 2 was a 22-year-old G2P1001 at 31 ^5/7 weeks. In both, preterm prelabor rupture of membranes (PPROM) workups yielded mixed results, prompting intra-amniotic dye testing. Due to a national indigo carmine shortage, sodium fluorescein was used. We present photographs of tampons examined under UV light, confirming PPROM in both cases. Methods Under ultrasound guidance, 5cc of sodium fluorescein was injected into the amniotic cavity. Patients wore a tampon for 15minutes while ambulating. Both provided consent for publication. Results On direct visualization, tampons appeared normal. Under UV light (Wood's lamp), the fluorescein emitted a bright neon green fluorescence. Both specimens demonstrated photoluminescence, confirming PPROM. Conclusion Although the use of 2 to 5cc of fluorescein for intra-amniotic dye testing is described in the literature, visual documentation of positive results is limited. These images may guide clinicians in confirming PPROM when indigo carmine is unavailable, supporting fluorescein as a viable diagnostic alternative. Key Points Fluorescein dye can be used to confirm PPROM when tampons are examined under UV light. We share unique images of positive fluorescein dye tests to confirm PPROM diagnosis. Images may aid diagnosis when indigo carmine is unavailable and fluorescein is used.

Duke Scholars

Author Jennifer B Gilner Obstetrics and Gynecology, Maternal Fetal Medicine

Author Sarah K. Dotters-Katz Obstetrics and Gynecology, Maternal Fetal Medicine